Overview
Dermatology in Australia is inseparable from skin cancer (the national melanoma and keratinocyte-cancer burden is the world's highest), plus inflammatory disease (eczema, psoriasis in the biologics era), paediatric dermatology, and procedural work from excisions and flaps to Mohs surgery and lasers. It is visual, pattern-based, procedural medicine conducted almost entirely in daylight hours.
Everyone has done this maths, which is why ACD selection is the most competitive gate in Australian medicine: hundreds of applicants for a few dozen places, a four-application lifetime cap, and successful CVs that resemble junior academic careers. The reward structure at the far end (demand, autonomy, income, hours) is unmatched.
The pathway
- PGY1–2Broad terms + every dermatology exposure you can engineer; start dermatology research early; it is effectively mandatory.
- Positioning years (PGY3–5+)Dermatology research fellow/registrar (unaccredited) jobs, higher degrees, publications, skin-cancer clinic work, plastics/immunology-adjacent terms.
- ACD selection (annual, state-based quotas)CV screen (academic record, research, dermatology experience, references) → shortlist → structured interviews → state training positions. Max 4 attempts (verified).
- Training years 1–4Accredited registrar posts (82% public hospital-based, verified); pharmacology + sciences exams then fellowship exams.
- FACD → consultantPrivate practice (most), public sessions, Mohs/laser fellowships, academic roles.
Formal requirements
- General registration; AU/NZ citizenship or PR.
- Minimum PGY2 completed at application; PGY3+ at commencement (check current ACD selection policy).
- Application through ACD's national process with state preferences; strict documentation; maximum of four applications ever (verified).
Selection and points
How selection works
| Component | What it involves |
|---|---|
| CV assessment | Scored across academic qualifications, clinical experience, demonstrated dermatology interest, research/publications, community & leadership (verified ACD criteria categories). |
| Referee assessment | Structured reports, dermatologist referees dominate in practice. |
| Structured interview | Shortlisted candidates only; combined CV + interview scores produce state-quota rankings. |
Points & scoring
- The unofficial 'entry standard': first-class academic record, multiple dermatology publications (often 5+), a research year or higher degree with a dermatology department, and dermatologists who know you well.
- Demonstrated dermatology interest is a scored category, dermatology conference presentations, skin-cancer clinic work and departmental attachment all count.
The unofficial view
- The de-facto pathway is the dermatology research fellow year(s): departments run unaccredited registrar/research posts that function as extended auditions. Getting one is itself competitive; apply nationally.
- The 4-application lifetime cap changes strategy: don't apply half-ready. Most successful candidates deliberately delay until their CV is genuinely competitive.
- State quotas mean geography matters: smaller states' quotas can be less oversubscribed; genuine flexibility helps.
- Skin-cancer-clinic GP work is a common holding pattern but does not substitute for departmental research visibility.
Competition & demographics
Competitiveness
- Fewer than 60 places offered nationally against several hundred eligible applicants, ratios of 5:1 or worse (verified commentary; ACD workforce snapshot).
- 114.5 total accredited positions nationally, 82% in public hospitals (verified ACD Dec 2024 snapshot).
- Median successful applicant is PGY5+ with multiple application cycles and a research portfolio.
Who's in the program
- ≈ 65% of trainees are women; the fellowship remains under-distributed regionally (61% of positions metro, verified).
Exams
| Exam | When | Format | Cost | Pass rate |
|---|---|---|---|---|
| ACD Pharmacology & Sciences examinations | Training years 1–2 | Written basic/clinical sciences | ≈ $2,000–3,500 each | Majority pass with preparation (indicative) |
| ACD Fellowship Examinations | Final year | Written + clinical/viva components | ≈ $5,000–8,000 | ≈ 70–85% (indicative) |
Fees and pass rates are indicative; check the college's current fee schedule and exam reports.
What training costs
- Application + selection fees per attempt; annual training fees ≈ $5,000–7,000 (check current schedule).
- Budget the hidden cost: 1–3 research/positioning years at registrar-or-below income before entry.
How to improve your chances at each stage
StageMedical student
- Start dermatology research in med school, seriously. Successful applicants' publication clocks usually started years before application.
- Learn dermoscopy basics and attend ACD student-accessible events; the community is small and long-memoried.
StageIntern (PGY1)
- Engineer dermatology exposure (relief terms, clinics, conference attendance); keep your academic transcript pristine; it is scored.
- Aim for 2+ publications moving by end of PGY2, at least one dermatology-specific.
StageResident (PGY2–3)
- Apply nationally for dermatology research fellow / unaccredited registrar posts; this is the real selection queue.
- Consider a research higher degree with a dermatology department; present at ACD ASM.
- Do not lodge a casual application: with a 4-attempt cap, apply when your CV is competitive, not before.
StageRegistrar years & applications
- In positioning years: referee cultivation across departments, interview coaching, and one substantial first-author paper beat five trivial ones.
- Reassess honestly after each attempt with feedback; the cap forces disciplined campaigns.
StageIf you don't get on (or change your mind)
- Adjacent careers doing overlapping work: GP with advanced skin-cancer surgery accreditation (huge regional demand, procedural, well remunerated), plastics (skin oncology), immunology, or medical oncology (melanoma). Several are better jobs than people admit while derm-fixated.
See also the general strategy guide: universal CV, referee and interview advice that applies across specialties.
Job market & workforce outlook
Outlook: Chronic undersupply, extreme in regional Australia, waitlists of months-to-years everywhere; cosmetic sector adds further private demand
- Demand is effectively unlimited: public clinic waits are months-long, regional Australia is drastically underserved, and biologics/complex-disease clinics keep growing.
- Private practice dominates (only ~18% of training positions' eventual work is public-weighted); new fellows fill books within weeks anywhere in the country.
Income
- Established private dermatology practices indicatively $500,000–1,000,000+; procedural (Mohs, laser) and high-volume skin-cancer practices at the top.
- Public-only dermatologists are rare; most blend token public sessions with private rooms.
Pre-tax, indicative, and highly variable with hours, setting and billing model. ATO figures are averages of taxable income by reported occupation.
Subspecialties & special interests
| Area | Notes |
|---|---|
| Mohs micrographic surgery | Fellowship-trained; top procedural tier |
| Paediatric dermatology | Deep shortage |
| Complex medical dermatology | Biologics clinics |
| Laser & cosmetic | Private sector growth |
International medical graduates
- SIMG assessment via ACD; dermatology is flagged as a priority candidate for the expedited pathway but not yet included as of early 2026 (verified).
Official links
Community: questions and perspectives
CommunityAsk questions and share real-world experience below. Sign in with your email (button top right) to post. Your training stage and specialty interest appear beside your name so readers know the perspective, and the best posts are folded into the page at each annual review.
❓ Questions & answers
Loading…
🩺 Experiences, corrections & perspectives
If you've trained in dermatology, or tried to, share what the page can't capture: what it's really like, what's changed, what you wish you'd known.
Loading…